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Inspection on 12/02/09 for Wolston Grange

Also see our care home review for Wolston Grange for more information

This inspection was carried out on 12th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Each care file case tracked had a pre-admission assessment that had been carried out in order for the home to decide if they could meet the needs of the prospective resident or not. The care files also included a checklist for staff to complete for each new resident to make sure that all important issues are addressed and to help the person settle in at Wolston Grange. Care plans for a person with mental health needs gave adequate instructions to staff on how they should manage the person`s behaviour. There were some positive comments made in the surveys returned to us regarding the care provided by people working at the home. Assessments for the risk of the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) had been devised and preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing sores. Residents` health care needs were being met by visits to or visits from health care professionals such as the district nurse, GP, optician and chiropodist. Whilst observing staff at work it was seen that the staff cared for residents with respect thereby maintaining the dignity and self esteem of the residents. Their preferred names were included in their care plans and were heard to be used by staff during the visit. People told us in the surveys and in conversation, that they enjoyed the meals provided at Wolston Grange. In the surveys and in discussion residents, or their representatives, said that they knew who to speak to if they had any concerns and that they knew how to make a complaint. Records viewed indicated that people who raise concerns are listened to and taken seriously. The home offers comfortable and mainly well maintained, decorated and furnished surroundings. The home had exceeded the required 50% of their care staff to have achieved the National Vocational Qualification in Care Level 2. This qualification shows that staff are competent in their role. The majority of staff had undertaken all mandatory training, giving them the knowledge and skills to make the home a safe place to live and work. All staff files looked at held the appropriate Criminal Records Bureau disclosure and Protection of Vulnerable Adults checks and two written references, thereby safeguarding residents from the employment of unsuitable people.

What has improved since the last inspection?

Appropriate risk assessments were in place with information on what action wasneeded to minimise any assessed risk. Medication keys were now kept by the person in charge of the shift in order to safeguard the residents` medication. Steps had been taken to assist the prevention of cross infection when residents or visitors entered the kitchen. An alarm had been fitted to the kitchen door to alert staff if had been opened and the hatch flap was placed down when the kitchen was unoccupied to act as a barrier to discourage people from entering unsupervised. A detached annexe had been developed in the courtyard of the home to accommodate younger adults with dementia. This had been decorated and furnished to a good standard. A summer house had been built in the grounds of the home for the benefit of the residents. The organisation had purchased a larger vehicle which meant that more people could be taken out on the weekly trips than previously. This gives more residents the opportunity for social needs to be met.

What the care home could do better:

Not all care plans had been reviewed regularly. They should be reviewed at a minimum of monthly intervals and when circumstances change, to ensure that all needs are met. Daily records were sometimes too brief and they were a kept in a disorganised manner, making it difficult to look back in records and to be able to glean what the person`s day had been like. Although the residents were mainly well groomed several of the female residents would have benefited from having their hair dressed/styled. There were several concerns related to the medication system, including the way in which the medication is stored, recorded, administered and the unsafe way in which it is transported to the residents. The system does not safeguard the residents` health and well being. Throughout the first four hours of the visit there was a strong smell of urine in the dining room but staff spoken with did not know where this was coming from. This was eventually addressed and a resident assisted with personal hygiene needs. In the meantime the person was at risk of developing sore skin, being uncomfortable and there being loss of dignity. Other residents had to experience unpleasant surroundings for a long period including during lunch. Staff need to develop and practice skills in order to manage continence appropriately. There were several choices for lunch but one of these choices was too cool to serve and also ran the chance of being a food hygiene concern because food temperatures had not been maintained.The behaviour of the dogs living in the annexe needs to be monitored to ensure the safety of anyone using the premises. Some window frames in communal areas were in need of repainting or repairing. Doors that act as fire doors should not be wedged open. Advice should be sought from the Fire Service in order to safeguard the people living and working at the home. Some of the bed linen looked at was thin and in need of being replaced in order to maintain the comfort of people living there. The management must ensure that there are systems in place that prevent the contamination by insects in the kitchen. Hand washing facilities must be managed in a way that maintains infection control in order to safeguard people living and working at the home. The laundry area was very untidy, with large amounts of dirty laundry on the floor and in bags and no obvious dirty or clean areas. This creates the possibility of cross infection occurring. The registered persons need to monitor that there are sufficient staff available to enable care staff to spend time with residents in order to meet their needs. Fire alarm checks had not been carried out each week, as is recommended, in either the main home or the new annexe. This is necessary to ensure that the equipment is working in the event of a fire. The new manager had not yet had the opportunity to be registered with us but an application needs to be made promptly.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ 02476540482 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Pinnacle Care Ltd care home 39 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 39 The maximum number of service users to be accommodated is 39 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 39 Date of last inspection Brief description of the care home Wolston Grange is one of seven homes owned by Pinnacle Care Limited. It is a large detached dwelling set in extensive grounds. The building was formerly a hunting lodge and there are a number of small outbuildings surrounding the main courtyard. A new Barn Annexe has been added to accommodate or five further people. The home is set in a rural location, a short drive away from Rugby Town Centre and the villages of Dunchurch and Bilton. The home is located along a country lane with smaller domestic dwellings as neighbours. There are no local facilities or public transport close to the home. It is registered to care for up to 39 older persons with dementia. The accommodation is over two floors. In the main home there are two lounges, a dining room, a large sun terrace and a conservatory. All bedrooms have ensuite facilities and there are two communal toilets on the ground floor and one on the upper Care Homes for Older People Page 4 of 37 Brief description of the care home floor. There are two assisted bathrooms and three shower facilities (one shower room not being used) within the building. Additional charges are made for chiropody, hairdressing and trips out in the organisations vehicle. The body of the Service User Guide also refers to charges for the labelling of clothes and any requests for special newspapers and magazines not provided by the home. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Wolston Grange. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment, (AQAA), which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users. Three were completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, Care Homes for Older People Page 6 of 37 (where possible) about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of some policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11:30am and 10:30pm. What the care home does well: What has improved since the last inspection? Appropriate risk assessments were in place with information on what action was Care Homes for Older People Page 8 of 37 needed to minimise any assessed risk. Medication keys were now kept by the person in charge of the shift in order to safeguard the residents medication. Steps had been taken to assist the prevention of cross infection when residents or visitors entered the kitchen. An alarm had been fitted to the kitchen door to alert staff if had been opened and the hatch flap was placed down when the kitchen was unoccupied to act as a barrier to discourage people from entering unsupervised. A detached annexe had been developed in the courtyard of the home to accommodate younger adults with dementia. This had been decorated and furnished to a good standard. A summer house had been built in the grounds of the home for the benefit of the residents. The organisation had purchased a larger vehicle which meant that more people could be taken out on the weekly trips than previously. This gives more residents the opportunity for social needs to be met. What they could do better: Not all care plans had been reviewed regularly. They should be reviewed at a minimum of monthly intervals and when circumstances change, to ensure that all needs are met. Daily records were sometimes too brief and they were a kept in a disorganised manner, making it difficult to look back in records and to be able to glean what the persons day had been like. Although the residents were mainly well groomed several of the female residents would have benefited from having their hair dressed/styled. There were several concerns related to the medication system, including the way in which the medication is stored, recorded, administered and the unsafe way in which it is transported to the residents. The system does not safeguard the residents health and well being. Throughout the first four hours of the visit there was a strong smell of urine in the dining room but staff spoken with did not know where this was coming from. This was eventually addressed and a resident assisted with personal hygiene needs. In the meantime the person was at risk of developing sore skin, being uncomfortable and there being loss of dignity. Other residents had to experience unpleasant surroundings for a long period including during lunch. Staff need to develop and practice skills in order to manage continence appropriately. There were several choices for lunch but one of these choices was too cool to serve and also ran the chance of being a food hygiene concern because food temperatures had not been maintained. Care Homes for Older People Page 9 of 37 The behaviour of the dogs living in the annexe needs to be monitored to ensure the safety of anyone using the premises. Some window frames in communal areas were in need of repainting or repairing. Doors that act as fire doors should not be wedged open. Advice should be sought from the Fire Service in order to safeguard the people living and working at the home. Some of the bed linen looked at was thin and in need of being replaced in order to maintain the comfort of people living there. The management must ensure that there are systems in place that prevent the contamination by insects in the kitchen. Hand washing facilities must be managed in a way that maintains infection control in order to safeguard people living and working at the home. The laundry area was very untidy, with large amounts of dirty laundry on the floor and in bags and no obvious dirty or clean areas. This creates the possibility of cross infection occurring. The registered persons need to monitor that there are sufficient staff available to enable care staff to spend time with residents in order to meet their needs. Fire alarm checks had not been carried out each week, as is recommended, in either the main home or the new annexe. This is necessary to ensure that the equipment is working in the event of a fire. The new manager had not yet had the opportunity to be registered with us but an application needs to be made promptly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 37 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information required to make a decision about choice of home is available when needed. Preadmission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: Two of the three surveys said that they had enough information about the home before moving in, with one not answering the question. The following comments were added. I inspected the home prior to (relatives) coming to live here. The home meets all (relatives)) needs, pleasant decor, flexible visiting times and excellent staff. I visited a number of homes before making a decision for my (relative). There was plenty of information available but visiting and absorbing layout, type of rooms, Care Homes for Older People Page 12 of 37 Evidence: atmosphere, friendliness, organisation etc is more important than documents. The home had a Statement of Purpose and Service User Guide in place but will need updating following the appointment of the new manager and to include details about the new annexe. The AQAA told us that each service user is provided with the Statement of Purpose, Service User Guide and a statement of terms and conditions and copies of the Statement of Purpose and Service User Guide were seen in some bedrooms viewed. Three care files were looked at as part of the case tracking process. Each had a pre admission assessment that had been carried out in order to assess if the home could meet the persons needs prior to offering them a place at the home. All the appropriate heading were included in the assessment and all medical conditions and needs were identified. There was sufficient detail to decide if the home could meet the persons needs or not. The files also included a Reception of New Resident Checklist which assisted in monitoring that all the important issues were addressed for a new person coming to live at the home, which should help the person in settling in to the home. A copy of the letter held on file showed that people had been informed in writing about the outcome of their pre-admission assessments. There was evidence of further assessment being carried out soon after admission thereby maintaining up to date information. Care Homes for Older People Page 13 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in the reviewing of care plans carry the risk of residents needs not being met. Residents have access to health care professionals. There was a shortfall in maintaining a residents dignity. There are concerns around the medication process that do not safeguard the well being of the people living at the home. Evidence: Three care files were looked as part of the case tracking process. Each contained care plans related to the needs identified in the assessments by means of a number to cross-reference against. They each set out the care required in sufficient detail so that all aspects of the health and personal health needs of residents were known to staff. A care plan related to personal care needs was kept in each residents bedroom so that the information was easily accessible to care staff when assisting the resident. The behavioural patterns of a person with mental health needs had been recorded and staff were given instructions on how to manage the behaviour, enabling the persons needs to be met. Care Homes for Older People Page 14 of 37 Evidence: Daily records were completed by both day and night care staff and related to the care plans. However on occasions the records were brief and each one looked at was kept in a disorganised manner making it difficult to look back in the records. One of the care plans looked at had no record of having been reviewed since June 2008. This creates the possibility of the plan not being up to date and needs not being met as a result. All care plans should be reviewed at a minimum of monthly and revised as circumstances change. Two people answered Always and one answered Usually to the surveys question, Do you receive the care and support you need and the following comments were added, The care is very good. (Relative) is included when discussing his care. The person who answered Usually also added, Yes the care and support is very good but Always is a strong word. There are 20-30 other residents, changes in staff, changes in our needs. No one is perfect. Two people answered Yes to the question Do the staff listen and act on what you say One person failed to answer. The following comments were added, Usually Yes but of course individuals needs have to be balanced with the needs of the whole community. Records for falls, pressure areas, weight and bathing nail checks were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores, (a break in the skin due to pressure, which reduces the blood supply to the area) manual handling nutrition and nutritional screening were also in place. These would help to minimise any risk in these areas. Individual risks were also assessed, for example suitable assessments were in place for a head wound and behaviour that may cause injury to other people living at the home. Preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing pressure sores. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician and chiropodist being identified in the care Care Homes for Older People Page 15 of 37 Evidence: files looked at. Residents spoken to confirmed they could see the doctor if they wished and that they had visits from the chiropodist, optician, district nurses and other health care professionals when necessary. The responses in the surveys when asked if residents received the medical support needed were Always or Usually. One survey told us of the patience and attention shown by staff regarding a relatives medical care. Residents were mainly well groomed and appropriately dressed but several of the female residents were in need of hairdressing. On our arrival and for four hours afterwards there was a strong smell of urine pervading the room and the adjoining areas. Staff were asked several times if they knew the source of the odour but to no affect. We eventually identified the source of the odour and on telling a member of staff this was addressed by a person living at the home being encouraged to accept assistance with their personal hygiene. The medication system was inspected. The pharmacist supplies most of the medicines in a monitored dosage system where each medicine is dispensed in a blister pack from which to administer on a daily basis. We looked at stored medication, and it was found that they are storing some medicines that are no longer needed. All medicines that are no longer prescribed must be returned to the pharmacy. One medicine was found to have a different name to the one it was prescribed for. This is poor practice and breaches regulations. The manager must ensure that proper management of medication occurs at all times. Some external medication was stored in the same trays as the internal medication. Internal and external medications need to be stored separately. As the AQAA told us the home had acquired a maximum-minimum thermometer but the medication fridge temperature records showed only the current temperature. To ensure that the correct temperature is constantly being maintained the minimum and maximum temperatures should also be recorded. The medication cupboard was also very warm. The home needs to demonstrate that this room is kept at a temperature of 25 degrees Centigrade or less. These steps will assist in ensuring that the medication is stored at the manufacturers recommended temperatures and their stability maintained. Eye drops had been dated when opened as they need to be disposed of within 28 days Care Homes for Older People Page 16 of 37 Evidence: of opening but one of these had not been appropriately disposed of and was still in use a week later. Two emollient creams and one ointment in a residents bedroom had not been dated on opening. All creams should be dated once opened and discarded after 28 days if they contain an active ingredient or three months if they are used as an emollient. Medication administration is carried out by taking each persons medicines individually from the medication cupboard in open medicine pots. This is not safe practice and the management must consider alternative systems to address this. Due to the temporary merge of two services the recording of the control drugs was not safe as two books were being used and several errors had been made. This was found by the newly appointed manager during monitoring and actions had been put into place to rectify this. The Medication Administration Records (MARS) were not completed properly and when we assessed some peoples medicines we found that in two out of five cases there was more medication than there should have been and in one case there was less. This implies that either staff are recording that medicines are given when not, the person has refused their medication and the appropriate code had not been used or one more tablet than signed for had been given or disposed of. The manager must ensure that accurate records are maintained. The manager had identified that there were concerns with the medication process and had already begun to address them. This improvement must be maintained. The AQAA told us that the home promoted privacy and dignity at all times and during the visit general observations showed that residents were cared for in a respectful manner, which ensures that their dignity and self esteem are maintained. However the incident of a person whose continence was not managed appropriately detracted from that persons dignity. The residents preferred name was recorded on care plans and heard to be used by staff. A telephone was available for residents to use in private. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activity and occupation relies on care staff and external entertainers. Visitors are made welcome and their needs considered. Residents have choices and control over their daily lives. Residents enjoyed the meals provided. Evidence: The home does not employ a designated activity organiser and this was commented upon in one of the surveys returned to us. At one time the home had an activities person with 25 hours allocated. She left and has not been replaced - recruitment problems I think. This is a pity - involvement is important. Further comments were, (relative) doesnt seem interested in taking part in othere activities though will watch. I wish there were more. (relative) is a loner and did enjoy walks in the grounds. Watches DVD of opera and Care Homes for Older People Page 18 of 37 Evidence: ballet when able to do so. Care staff were responsible for providing occupation to the residents. In addition to this there were organised activities provided by outside contractors, including movement to music, reminiscence sessions and entertainers. The activities provided were evidenced in daily records but those looked at did not show that people living at the home are provided with regular occupation and stimulation. During the visit staff were seen to be chatting with residents but no other activity was observed. The manager told us that some had taken place whilst we were looking at records in another area of the home. The organisation has its own vehicle and is used to take residents on trips. The AQAA told us that it had been replaced for a bigger one . Although the AQAA told us we have found more places to go on outings , other information told us that an outing was usually a drive and a pub lunch at one of two local pubs. The residents pay for the trip and the meal in addition to the accommodation charges. One relative told us that this outing was too expensive but another relative said, There is a weekly bus outing for a drive and a meal out which my (relatives) seems to enjoy. The manager must ensure that the person going on the outing or their representative are clear about what the cost covers and agree with this. Visiting was at any reasonable time and in one survey a person said that flexible visiting met their relatives needs. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat and where to spend their time. The menu offered a nutritionally balanced choice over a four- week cycle. The meals being served for lunch had been changed from fish to gammon. The chef said that this was because the freezer had malfunctioned and the gammon had begun to defrost. The chef had thought it appropriate to use this. When asked about the other food in the freezer we were given assurances that nothing else still in the freezer had begun to defrost, but no evidence that the temperature of the food had been maintained as cold enough was provided. The alternative main courses were chicken pie or pasties and the meals were brought to the dining room in a heated trolley. Although the food looked appetising some of it Care Homes for Older People Page 19 of 37 Evidence: was not of a high enough temperature for either reasons of health or enjoyment. The chef attended to this as soon as informed of these findings. However people spoken with after lunch had been taken said that they had enjoyed what they had eaten. One of the desserts was meant to be melon in port but the melon was served without the port as the chef said that they had run out of this. During lunch there were two members of staff assisting people to eat and one serving food to the other residents. The manager was assisting other residents but there were no other care staff available to deal with any other incidents that occurred. At tea time a member of the care staff needed to finish the meal that had been prepared earlier by the cook. People answered in the surveys that they liked the meals at the home, although one relative said, (Relative) does not always like the menu but usually manages a balanced diet. This comment was also made to us by another relative who said that pastas were not enjoyed. Care Homes for Older People Page 20 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies and procedures to safeguard residents. Evidence: The complaint procedure was displayed in the home in order that people living and visiting the home knew how to make a complaint. All three people who answered the surveys said that they knew who to speak to if they were not happy and how to make a complaint. They added the following comments, All staff are aware of (relatives) needs and any problems are sorted at once. The manager of the home and the directors of the company are usually available. I may be referred from one to the other but thats no problem. Manager available when we meet to discuss (relatives) needs. There is a complaints procedure document. A complaints log was maintained by the home and this showed that complaints had been appropriately addressed and managed. This gives people the confidence that their concerns will be listened to. A complaint regarding a persons care was being Care Homes for Older People Page 21 of 37 Evidence: addressed at the time of this report. Training records and with staff showed that the majority of staff had undertaken training related to safeguarding adults in order that they were able to identify abuse and what to do if they suspected or witnessed abuse in the home. Discussion with the manager showed that she had an awareness of safeguarding issues in order to safeguard residents. All recruitment practices safeguard residents from the employment of unsuitable people. Financial interests of residents are taken out of the hands of staff at the home and any purchases made on residents behalf such as hairdressing, chiropody, outings or meals out are invoiced by head office to the person responsible for their financial affairs. The records for these are not held in the home and were not available for inspection. Care Homes for Older People Page 22 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there comfortable surroundings, which are clean and generally safe and well maintained but with some shortfalls. It was not free of offensive odour. Evidence: Wolston Grange is a converted hunting lodge set in extensive grounds in a rural location surrounded by farmland and countryside. It is accessed along a country lane but sign posted from the main road. A new annexe had been opened in the courtyard that was registered with us and was to care for five younger people with dementia, but occupied by only one person at the time of the visit. The communal living space was open plan, with a small kitchenette and dining area and a large living/activity area, which housed a snooker table. Bedrooms had en-suite facilities and there was an assisted bathroom on the ground floor. The building had been decorated and furnished to a good standard. Two Labrador dogs were also living in the annexe, one of which had been brought form a home that was closed for refurbishment. They were excitable, jumping up at us as we entered the building and later when sitting with a service user, and could pose a problem to anyone either visiting or living in the annexe, particularly if they had problems with balance. This needs to be monitored to ensure the safety of anyone Care Homes for Older People Page 23 of 37 Evidence: using the annexe. A caravan was also in the grounds, which we were told was used by a building contractor working for the organisation. Areas of garden for residents use were accessible and well maintained. A summerhouse had been built in the gardens providing an attractive outdoor space for the people living at the home. There had been no major changes in the main part of the home, with the two lounges being divided by the dining room and reception area. The areas are decorated and furnished to a good standard, looking comfortable and attractive. The floor covering was in good condition but as before was of a busy pattern that research has shown can be confusing for people with dementia. There were residents sitting in the dining room throughout the visit. The home also has an attractive conservatory but was only used that day by staff for report writing. Bedrooms belonging to the people case tracked were also viewed and all were personalised by belongings, such as photos, pictures and ornaments, of the occupants and were comfortable and well presented. Bed linen in some of the rooms was thin and in need of replacing. Curtains were good quality and matched the rooms well. All rooms had en-suite facilities. A bathroom by the kitchen was being used as a storeroom. The manager told us that this was to be redesigned and refurbished in the near future. All communal areas were well decorated and furnished with many of the original features such as wooden wall panels and traditional fireplaces. Most of the windows were also original but some of the frames were in need of repainting or repair. A window in the lounge known as the library had recently been repaired but a complaint to us received after the inspection said that this had been broken for some time and had been left unsafe. Continence aids had been delivered that day and had been stored in the library, which would have prevented the room being comfortably used by people living at the home or by visitors. A comment made in one of the surveys said, The homes layout and decor are excellent for (relatives) needs. The surveys showed that people found the home Always or Usually fresh and clean and commented, Excellent cleaning lady. Care Homes for Older People Page 24 of 37 Evidence: There are 20-30 residents here. Many are incontinent. Perfection isnt possible but the staff do very well in the circumstances. Whilst the dining was a pleasant area for people to take their meals, and as previously mentioned, there was a strong smell of urine in the room and adjoining areas for several hours. The kitchen door was found to be wedged open by a bag of grit. The door in this high risk area should only be held open only by a device linked to the fire alarm and of which the fire service approves, or kept closed, to prevent the passage of smoke or flames into the home in the event of a fire. Substances hazardous to health were stored on an open shelf by the kitchen door and these were easily accessible to residents, posing a hazard to those people with limited mental capacity. The items were said to have been delivered that day. They were stored safely once we pointed out the concern of health and safety. Steps had been taken to assist the prevention of cross infection when residents or visitors entered the kitchen. An alarm had been fitted to the kitchen door to alert staff if had been opened and a the hatch flap was placed down when the kitchen was unoccupied to act as a barrier to discourage people from entering unsupervised. There were no fly screens in the kitchen and this had been approved by Environmental Health, providing that food is protected from contamination by insects. The windows in the kitchen were open and uncovered food was left out on the worktop. The manager must ensure that food is stored in a way to prevent contamination. Soap dispensers were in use and alcohol hand gel dispensers were available in a cupboard for infection control purposes in all hand washing areas viewed. However the alcohol gel dispensers were empty in some areas. The organisation does not use disposable towels and provide single-use fabric towels which are intended to be sent to the laundry after each use. The ones available at the time of the visit were small pieces of faded towelling stored on the toilet cistern in some areas as there was no other storage for them. One area was without any towels. The laundry bins in the bathrooms and toilets for used towels were without lids. However the manager told us that she had ordered a supply of new small towels and had new bins that had not yet been put in place. In each toilet and bathroom and some bedrooms viewed there was an open clinical waste bag tied to a towel rail or doorknobs. When discussed with the manager we were told that this had been done to cater for more waste to dispose of during the Care Homes for Older People Page 25 of 37 Evidence: recent viral infection outbreak. As they were open they could be a source of cross infection and need to be kept in container with a lid. The manager advised us that these had been removed before the end of the visit as they were no longer needed. The laundry area was very untidy with dirty laundry on the floor and no obvious separation of clean and dirty laundry, creating the chances of cross infection. Colour coded bags had been provided so that laundry could be appropriately sorted but were not being used properly. There was a large build up of spilt soap powder on top of the washing machine. There are no designated laundry assistants with domestic and day and night care staff being responsible for this. By 10pm there was a large amount of dirty laundry waiting to be done. Care Homes for Older People Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient care staff available to meet the needs of the residents but the low numbers of ancillary staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The manager said that the usual complement of care staff was four on each day shift, which would also include the senior member of staff, and two during the night. The senior person working the evening shift is on call during the night. A further member of staff works in the new annexe at each shift, including night duty, whilst there was only one person staying there. On the day of the visit a care assistant had accompanied a resident to an unplanned visit to hospital and therefore there were only two care assistants and a deputy manager on duty. The manager was attending a training course but chose to return to the home when she was informed that the inspection visit was taking place. There were thirty five hours a week of housekeeping over a five days a week, but the manager advised that she was about to recruit to a further 14 hours at weekends. The care staff need to assist with providing the teatime meal as the catering staff only work 8am to 2pm. The home does not employ designated laundry assistants and the Care Homes for Older People Page 27 of 37 Evidence: laundry tasks are carried out mainly by the night staff, although day staff also do some laundry between other tasks. Time taken to carry out laundry and catering tasks is time taken away from residents, which could impact on their needs being met. The head office carries out the majority of the administration and therefore there are no administrative staff at the home. The following comments were made in the surveys in relation to staff at the home, I find the staff conversant with dementia. There have been many staff changes and I am saddened by this but understand the problems. It is a very tough job with different shifts and poor pay. This place is also awkward to access. Never the less Ive seen very few who arent utterly dedicated, patient and kind. It would help if there were higher staff ratios. In answer to the question, Are staff available when you need them surveys said, Always or Usually and the following comment was made in one of them, There are demands on staff. A higher staff ratio is always beneficial. The home had exceeded the required fifty percent of care staff to have achieved National Vocational Qualification (NVQ) Level 2 in Care. This qualification shows that the person has been assessed as competent in their role. Three staff files were looked at. The AQAA told us that all staff had the right documents before being allowed to start work , and this was confirmed in the files looked at. All staff files contained the appropriate Criminal Records Bureau clearance, Protection of Vulnerable Adults clearance, two written references and an employment history. Two of the application forms showed gaps in employment. One of these had been checked and the validity of the gaps recorded but the second showed no evidence that this had been done. Training records were examined. The majority of staff had undertaken all mandatory training, such as Moving and Handling, Food Hygiene, First Aid and Safeguarding Adults. Not all staff had undertaken Fire Safety from a approved trainer in the last year but the majority had undertaken in-house training. Several staff had undertaken infection control. Most of the care staff had undertaken training related to dementia; six of them had attended the one day course since the last inspection with only one person attending the three day course in the past year. the training managing dementia seems insufficient given the category of su at the home. the owner is well Care Homes for Older People Page 28 of 37 Evidence: trained on dementia. Care Homes for Older People Page 29 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate qualifications and who has previous management experience manages the home. Monitoring and auditing of the service and practices assess that all services operate in the best interests of residents. There are concerns about the security of receiving visitors that create a risk to confidentiality and safety of the residents. Shortfalls in health and safety practice do not protect residents and staff at the home. Evidence: The AQAA had been completed by the previous manager and our questions were not fully answered. The registered manager had resigned in January 2009 and the registered manager of another service belonging to the organisation had been acting manager. This service had been closed for refurbishment and several of the residents and staff had temporarily transferred to Wolston Grange. Care Homes for Older People Page 30 of 37 Evidence: A new manager had been appointed to Wolston Grange two weeks before the visit. She had previously managed a nursing home, was a Registered General Nurse and had achieved the Registered Managers Award, giving her the appropriate training and experience to apply for registration with us. This should be done promptly. She had made progress in identifying the areas of improvement needed in the home and had taken steps to address some of them. She is supported in the senior team by the deputy manager and two team leaders. The senior staff are included in the number of care staff on duty. The organisation had a Quality Assurance programme and includes monthly visits by a representative of the company; surveys distributed to service users or their representatives for feedback on their views of the service; meetings with relatives. These systems indicate that the home is monitoring the service in order to enable growth and improvement. The home does not hold any monies for any of the people living at the home. Any purchases made, such as hairdressing, chiropody or for trips and meals out are invoiced monthly to the person responsible for the residents finances. Records of these transactions were not available for inspection as they are dealt with by head office. Staff had undertaken mandatory training to give them the knowledge and skills required regarding health and safety issues, including moving and handling, food hygiene, infection control and first aid. The majority of staff had undertaken in house fire training in the last year. There was evidence from a random check of records that equipment was regularly serviced and maintained and health and safety checks were carried out. However the fire alarm tests had not been carried out each month as required. We were told that this was due to a fault but there was no written information to confirm this. The systems must be tested weekly and if this is not possible this should be clearly recorded. There needs to be an effective system for recording who is visiting the home and establishing who the visitors are in order to protect the people living at the home. We were not asked for our identity on arrival at the home and left unsupervised outside an unlocked office whilst the staff located the person in charge. There was confidential service user information on full view to any one entering the office. As discussed in the Environment section of this report the management must monitor Care Homes for Older People Page 31 of 37 Evidence: the behaviour of the dogs in the Barn Annexe to ensure that it does not pose a risk to people using or visiting the premises. As referred to in the Daily Life and Social Activities section of this report items of cleaning materials that were hazardous to health had been left on open shelving by the open kitchen door. These substances need to be locked away to avoid any risk to vulnerable people. Care Homes for Older People Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Every effort must be made to ensure that continence is managed appropriately and respectfully. This will maintain the comfort and dignity of the people living at the home. 11/06/2009 2 9 13 Medication must only be 11/06/2009 used for the person to whom it has been prescribed. This will ensure the health and well being of the people at the home. 3 12 7 The management must 11/06/2009 ensure that the person going on an outing or their representative are clear about what the cost covers and agree with this. This will ensure that residents have the information they need to make a choice. Care Homes for Older People Page 34 of 37 4 15 16 Food must be shown to be stored and served at appropriate temperatures. This will maintain food hygiene and safeguard the health of the people eating at the home. 11/06/2009 5 19 23 Advice must be sought regarding a safe system for holding the internal kitchen door open and regarding its effectiveness to hold back fire and smoke. This will safeguard people living and working in the home in the event of a fire. 30/06/2009 6 26 13 Appropriate facilities, including waste bins, must be available in communal areas where staff and residents are expected to wash their hands. This will maintain infection control and thereby safeguard residents health adn welfare. 11/06/2009 7 26 13 The laundry area must be 11/06/2009 properly managed to control infection. This will safeguard residents from cross infection. 8 38 13 Substances hazardous to health must be kept in a secure location at all times. This will safeguard the people using the service. 11/06/2009 Care Homes for Older People Page 35 of 37 9 38 23 Fire alarms should be checked weekly to ensure that they are in full working order. This will protect people living and working at the home in the event of a fire. 11/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 7 7 9 9 Daily records should be in more detail and information in them be easily accessible. Care plans should be reviewed at a minimum of monthly intervals and revised as circumstances change. Medication for internal and external use should be stored separately. The manager should maintain improvements in the medication system that ensures the well being of the residents. The management of continence and personal care should maintain the dignity of the people living at teh home. The management should demonstrate that residents are provided with sufficient ongoing and appropriate activity and stimulation. An assessment of the windows and frames throughout the home should be made and any necessary repairs or redecoration carried out. The kitchen should be protected against contamination by insects. The manager should apply for registration with us promptly. The behaviour of the dogs in the Barn Annexe shouldbe monitored to assess the risk to people using and visiting the premises and any necessary action taken. 5 6 10 12 7 19 8 9 10 26 31 38 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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